N. Dakota, Washington win Miss America prelims

LAS VEGAS (AP) — Miss North Dakota and Miss Washington have picked up prizes in the third day of preliminary Miss America competition in Las Vegas.

Miss North Dakota Rosie Sauvageau took top honors Thursday after her piano and vocal rendition of “To Make You Feel My Love.” The 24-year-old from Fargo, N.D., will take a $ 2,000 Amway scholarship home from the competition at Planet Hollywood resort.

Miss Washington Mandy Schendel took the trophy for the third round of the Lifestyle and Fitness category after modeling a strapless white Catalina swimsuit. The 22-year-old from Newcastle, Wash., earned a $ 1,000 Amway scholarship for it.

Contestants are divided into three groups and compete in different categories during three nights of preliminaries. Their scores will factor in the finals that will be broadcast live on Saturday.

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The New Old Age Blog: Taking a Zen Approach to Caregiving

You try to help your elderly father. Irritated and defensive, he snaps at you instead of going along with your suggestion. And you think “this is so unfair” and feel a rising tide of anger.

How to handle situations like this, which arise often and create so much angst for caregivers?

Jennifer Block finds the answer in what she calls “contemplative caregiving” — the application of Buddhist principles to caregiving and the subject of a year-long course that starts at the San Francisco Zen Center in a few weeks.

This approach aims to cultivate compassion, both for older people and the people they depend on, said Ms. Block, 49, a Buddhist chaplain and the course’s lead instructor. She’s also the former director of education at the Zen Hospice project in San Francisco and founder of the Beyond Measure School for Contemplative Care, which is helping develop a new, Zen-inspired senior living community in the area.

I caught up with Ms. Block recently, and what follows is an edited transcript of our conversation.

Let’s start with your experience. Have you been a caregiver?

My experience in caregiving is as a professional providing spiritual care to individuals and families when they are facing and coping with aging and sickness and loss and dying, particularly in hospital and hospice settings.

What kinds of challenges have you witnessed?

People are for the most part unprepared for caregiving. They’re either untrained or unable to trust their own instincts. They lack confidence as well as knowledge. By confidence, I mean understanding and accepting that we don’t know all the answers – what to do, how to fix things.

This past weekend, I was on the phone with a woman who’d brought her mom to live near her in assisted living. The mom had been to the hospital the day before. My conversation with the daughter was about helping her see the truth that her mother needed more care and that was going to change the daughter’s responsibilities and her life. And also, her mother was frail, elderly, and coming nearer to death.

That’s hard, isn’t it?

Yes, because we live in a death-denying society. Also, we live in a fast-paced, demanding world that says don’t sit still — do something. But people receiving care often need most of all for us to spend time with them. When we do that, their mortality and our grief and our helplessness becomes closer to us and more apparent.

How can contemplative caregiving help?

We teach people to cultivate a relationship with aging, sickness and dying. To turn toward it rather than turning away, and to pay close attention. Most people don’t want to do this.

A person needs training to face what is difficult in oneself and in others. There are spiritual muscles we need to develop, just like we develop physical muscles in a gym. Also, the mind needs to be trained to be responsive instead of reactive.

What does that mean?

Here’s an example. Let’s say you’re trying to help your mother, and she says something off-putting to you like “you’ve always been terrible at keeping house. It’s no wonder you lost my pajamas.”

The first thing is to notice your experience. To become aware of that feeling, almost like being slapped emotionally. To notice your chest tightening.

Then I tell people to take a deep breath. And say something to themselves like “soften” to address that tightness. That’s how you can stay facing something uncomfortable rather than turning away.

If I were in this position, I might say something to myself like “hello unhappiness” or “hello suffering” or “hello aging” to tether myself.

The second step would be curiosity about that experience. Like, wow, where do I feel that anger that rose up in me, or that fear? Oh, it’s in my chest. I’m going to feel that, stay with it, investigate it.

Why is that important?

Because as we investigate something we come to understand it. And, paradoxically, when we pay attention to pain it changes. It softens. It moves. It lessens. It deepens. And we get to know it and learn not to be afraid of it or change it or fix it but just come alongside of it.

Over hours, days, months, years, the mind and heart come to know pain. And the response to pain is compassion — the wish for the alleviation of pain.

Let’s go back to what mother said about your housekeeping and the pajamas. Maybe you leave the room for five minutes so you can pay attention to your reaction and remember your training. Then, you can go back in and have a response rather than a reaction. Maybe something like “Mom, I think you’re right. I may not be the world’s best housekeeper. I’m sorry I lost your pajamas. It seems like you’re having a pretty strong response to that, and I’d like to know why it matters so much to you. What’s happening with you today?”

Are other skills important?

Another skill is to become aware of how much we receive as well as give in caregiving. Caregiving can be really gratifying. It’s an expression of our values and identity: the way we want the world to be. So, I try to teach people how this role benefits them. Such as learning what it’s like to be old. Or having a close, intimate relationship with an older parent for the first time in decades. It isn’t necessarily pleasant or easy. But the alternative is missing someone’s final chapter, and that can be a real loss.

What will you do in your course?

We’ll teach the principles of contemplative care and discuss them. We’ll have homework, such as ‘Bring me three examples of someone you were caring for who was caring toward you in return.’ That’s one way of practicing attention. And people will train in meditation.

We’ll also explore our own relationship to aging, sickness, dying and loss. We’ll tell our stories: this is the situation I was in, this is where I felt myself shut down, this was the edge of my comfort or knowledge. And we’ll teach principles from Buddhism. Equanimity. Compassion. Deep inner connectedness.

What can people do on their own?

Mindfulness training is offered in almost every city. That’s one of the core components of this approach.

I think every caregiver needs to have their own caregiver — a therapist or a colleague or a friend, someone who is there for them and with whom they can unburden themselves. I think of caregiving as drawing water from a well. We need to make sure that we have whatever nurtures us, whatever supplies that well. And often, that’s connecting with others.

Are other groups doing this kind of work?

In New York City, the New York Zen Center for Contemplative Care educates the public and professionals about contemplative care. And in New Mexico, the Upaya Zen Center does similar work, much of it centered around death and dying.

People who want to read about this might want to look at a new book of essays, “The Arts of Contemplative Care: Pioneering Voices in Buddhist Chaplaincy and Pastoral Work” (Wisdom Publications, 2012).

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DealBook: Wells Fargo Profit Jumps 24% in Quarter, Driven by Mortgage Gains

8:46 a.m. | Updated

Wells Fargo reported $5.1 billion in profit for the fourth quarter on Friday, a 24 percent increase, driven by the bank’s lucrative mortgage business.

Seizing on low-interest rates that have spurred a flurry of refinancing activity, the bank again notched record profits. For the last 12 quarters, profits at the bank have increased.

In this latest quarter, Wells Fargo, based in San Francisco, reported earnings of 91 cents a share, which exceeded analysts’ expectations. Ahead of the report, analysts polled by Thomson Reuters estimated that the bank would report earnings of 89 a share.

Wells Fargo, unlike many of its rivals, has been able to steadily increase its revenue. The first bank to release fourth-quarter earnings, Wells Fargo reported $21.95 billion in revenue in the fourth quarter, up 7 percent from a year earlier.

Much of the revenue gains stemmed from the bank’s consumer lending business, as borrowers jumped on record low interest rates to refinance their mortgages. Wells Fargo, which dominates the market as the nation’s largest mortgage lender, notched $125 billion in mortgage originations, up from $120 billion in the fourth quarter of 2011. Refinancing applications accounted for nearly 75 percent of that total.

The big profit in the group came from the extra money that Wells Fargo makes bundling the mortgages into bonds and selling them to the government. In the fourth quarter, the bank reported $2.8 billion of so-called net gains on its mortgages activities, up 51 percent from the previous year.

Under the tenure of its chief executive, John G. Stumpf, Wells Fargo has aggressively expanded into the mortgage market, a strategy that might help the bank surpass its rivals in profits, notably JPMorgan Chase.

Wells Fargo’s net interest margin, a closely watched profit metric that measures the difference between the interest the bank collects and the interest it pays on its own borrowings, was down slightly to 3.56 percent, from 3.89 percent a year earlier.

Profit in the community banking division, which spans Wells Fargo’s retail branches and mortgage business, increased 14 percent to $2.9 billion.

The bank successfully courted more cash from depositors, adding $72 billion in total core checking and savings deposits than a year earlier.

“The company’s underlying results were driven by solid loan growth, improved credit quality, and continued success in improving efficiency,” Wells Fargo’s chief financial officer, Tim Sloan, said in a statement.

The bank has benefited from sweeping federal stimulus initiatives that have buoyed the mortgage business. The Treasury Department has helped spur Americans to refinance their mortgages.

Wells Fargo is the reigning titan in the mortgage industry, generating roughly a third of all the mortgages across the United States. Mortgage originations continued to climb, up 4 percent to $125 billion.

Adding to its mortgage-related profit, Wells Fargo reported a $926 million profit from its servicing business, in which the bank collects payments from homeowners. That’s up roughly 6 percent from a year earlier.

Alongside the consumer loan business, Wells Fargo had gains in its wealth management business, a particular focus for the bank to defray the impact of federal regulations that dragged down profits elsewhere.

Still, Wells Fargo’s profit from residential mortgages could wane this year if the Federal Reserve halts its extensive bond buying spree.

Working to move beyond the mortgage crisis woes that have dogged the bank, Wells Fargo has been brokering deals with federal regulators. Wells Fargo was one of 10 banks that signed onto an $8.5 billion settlement this week with the Comptroller of the Currency and the Federal Reserve over claims that shoddy foreclosure practices may have led to the wrongful eviction of homeowners.

The sweeping federal pact ends a deeply flawed review of millions of loans in foreclosure that was mandated by federal regulators in 2011. The review, which was ended this week, began in November 2011 amid mounting public fury that bank employees were churning through hundreds of foreclosure filings without reviewing them for accuracy.

In addition to the settlement, the bank set aside $1.2 billion to prevent foreclosures.

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Irvine City Council overhauls oversight, spending on Great Park

Capping a raucous eight-hour-plus meeting, the Irvine City Council early Wednesday voted to overhaul the oversight and spending on the beleaguered Orange County Great Park while authorizing an audit of the more than $220 million that so far has been spent on the ambitious project.

A newly elected City Council majority voted 3 to 2 to terminate contracts with two firms that had been paid a combined $1.1 million a year for consulting, lobbying, marketing and public relations. One of those firms — Forde & Mollrich public relations — has been paid $12.4 million since county voters approved the Great Park plan in 2002.

"We need to stop talking about building a Great Park and actually start building a Great Park," council member Jeff Lalloway said.

The council, by the same split vote, also changed the composition of the Great Park's board of directors, shedding four non-elected members and handing control to Irvine's five council members.

The actions mark a significant turning point in the decade-long effort to turn the former El Toro Marine base into a 1,447-acre municipal park with man-made canyons, rivers, forests and gardens that planners hoped would rival New York's Central Park.

The city hoped to finish and maintain the park for years to come with $1.4 billion in state redevelopment funds. But that money vanished last year as part of the cutbacks to deal with California's massive budget deficit.

"We've gone through $220 million, but where has it gone?" council member Christina Shea said of the project's initial funding from developers in exchange for the right to build around the site. "The fact of the matter is the money is almost gone. It can't be business as usual."

The council majority said the changes will bring accountability and efficiencies to a project that critics say has been larded with wasteful spending and no-bid contracts. For all that has been spent, only about 200 acres of the park has been developed and half of that is leased to farmers.

But council members Larry Agran and Beth Krom, who have steered the course of the project since its inception, voted against reconfiguring the Great Park's board of directors and canceling the contracts with the two firms.

Krom has called the move a "witch hunt" against her and Agran. Feuding between liberal and conservative factions on the council has long shaped Irvine politics.

"This is a power play," she said. "There's a new sheriff in town."

The council meeting stretched long into the night, with the final vote coming Wednesday at 1:34 a.m. Tensions were high in the packed chambers with cheering, clapping and heckling coming from the crowd.

At one point council member Lalloway lamented that he "couldn't hear himself think."

During public comments, newly elected Orange County Supervisor Todd Spitzer chastised the council for "fighting like schoolchildren." Earlier this week he said that if the Irvine's new council majority can't make progress on the Great Park, he would seek a ballot initiative to have the county take over.

And Spitzer angrily told Agran that his stewardship of the project had been a failure.

"You know what?" he said. "It's their vision now. You're in the minority."

mike.anton@latimes.com

rhea.mahbubani@latimes.com

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Disk Jockey: Hear Your Favorite Theme Songs Played by a Floppy-Drive Orchestra

While making music with computers is nothing new, it’s rarely quite so literal as the melodies of Youtube user MrSolidSnake74, who transformed eight floppy disk drives into an orchestra of MIDI magic. In the gallery above, you can hear his arrangements based on popular themes from Super Mario Bros, Doctor Who, Ghostbusters, Mega Man, Star Trek: The Next Generation, Game of Thrones and more, as performed by his floppy disk “instruments.”

“The concept behind this is basically getting the stepper motor to operate a certain frequency (getting the motor to step a certain amount of times in a second) which generates a pitch. Then we arrange those pitches together and we get a song,” he explained.

After creating his own arrangements of songs, he uses code written by a Youtube user named Sammy1Am to transform MIDI files into serial data packets, and sends them to an Arduino — an open-source microcontroller board – which routes the information to the floppy drives.

Want to make your own musical disk drives? Check out the Sammy1A how-to video:

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‘Lincoln’ leads Oscars with 12 nominations

BEVERLY HILLS, Calif. (AP) — The Civil War saga “Lincoln” leads the Academy Awards with 12 nominations, including best picture, director for Steven Spielberg and acting honors for Daniel Day-Lewis, Sally Field and Tommy Lee Jones.

Also among the nine nominees for best picture Thursday: the old-age love story “Amour”; the Iran hostage thriller “Argo”; the independent hit “Beasts of the Southern Wild”; the slave-revenge narrative “Django Unchained”; the musical “Les Miserables”; the shipwreck story “Life of Pi”; the lost-souls romance “Silver Linings Playbook“; and the Osama bin Laden manhunt chronicle “Zero Dark Thirty.”

“Life of Pi” surprisingly ran second with 11 nominations, ahead of “Zero Dark Thirty” and “Les Miserables,” which had been considered potential front-runners.

More surprising were snubs in the directing category, where three favorites missed out: Ben Affleck for “Argo” and past Oscar winners Kathryn Bigelow for “Zero Dark Thirty” and Tom Hooper for “Les Miserables.” Bigelow was the first woman ever the win the directing Oscar for 2009′s “The Hurt Locker,” while Hooper won a year later for “The King’s Speech.”

The best-picture category also had surprising omissions. The acclaimed first-love tale “Moonrise Kingdom” was left out and only got one nomination, for original screenplay. Also snubbed for best-picture was “The Master,” a critical favorite that did manage three acting nominations for Joaquin Phoenix, Amy Adams and Philip Seymour Hoffman.

Two-time winner Spielberg earned his seventh directing nomination, and also in the mix are past winner Ang Lee for “Life of Pi” and past nominee David O. Russell for “Silver Linings Playbook.” The other slots went to surprise picks who are first-time nominees: Michael Haneke for his French-language “Amour” and Benh Zeitlin for “Beasts of the Southern Wild.”

“Amour” also was a best-picture surprise. The film, which won the top prize at last May’s Cannes Film Festival, mainly had been considered a favorite in the foreign-language category, where it also was nominated. “Amour” had five nominations, including original screenplay and best-actress for Emmanuelle Riva.

The year’s second-biggest box-office hit, “The Dark Knight Rises,” was shut out entirely, even for visual effects. The omission of its predecessor, “The Dark Knight,” from best-picture consideration for 2008, was largely responsible for the expansion of the Oscar category from five nominees to 10 the following year. “The Dark Knight” had earned eight nominations and won two Oscars.

Chronicling Abraham Lincoln’s final months as he engineers passage of the 13th Amendment abolishing slavery, “Lincoln” stars best-actor contender Day-Lewis in a monumental performance as the 16th president, supporting-actress nominee Field as the notoriously headstrong Mary Todd Lincoln and supporting-actor prospect Jones as abolitionist firebrand Thaddeus Stevens.

Joining Day-Lewis in the best-actor field are Bradley Cooper as a psychiatric patient trying to get his life back together in “Silver Linings Playbook”; Hugh Jackman as Victor Hugo’s tragic hero Jean Valjean in “Les Miserables”; Phoenix as a Navy vet who falls in with a cult in “The Master”; and Denzel Washington as a boozy airline pilot in “Flight.”

Cooper had been a bit of a longshot. John Hawkes, a potential best-actor favorite, missed out for his role as a man in an iron lung aiming to lose his virginity in “The Sessions.”

Nominated for best actress are Jessica Chastain as a CIA operative hunting bin Laden in “Zero Dark Thirty”; Jennifer Lawrence as a troubled young widow struggling to heal in “Silver Linings Playbook”; Riva as an ailing woman tended by her husband in “Amour”; Quvenzhane Wallis as a spirited girl on the Louisiana delta in “Beasts of the Southern Wild”; and Naomi Watts as a mother caught up in a devastating tsunami in “The Impossible.”

Best actress had a wild age range: Riva is the oldest nominee ever in the category at 85, while Wallis is the youngest ever at 9.

Along with Field, supporting-actress nominees are Adams as a cult leader’s devoted wife in “The Master”; Anne Hathaway as an outcast mother reduced to prostitution in “Les Miserables”; Helen Hunt as a sex surrogate in “The Sessions”; and Jacki Weaver as an unstable man’s doting mom in “Silver Linings Playbook.”

Besides Jones, the supporting-actor contenders are Alan Arkin as a wily Hollywood producer in “Argo”; Robert De Niro as a football-obsessed patriarch in “Silver Linings Playbook”; Hoffman as a dynamic cult leader in “The Master”; and Christoph Waltz as a genteel bounty hunter in “Django Unchained.”

“Family Guy” creator Seth MacFarlane, who will host the Feb. 24 Oscars, joined Emma Stone to announce the Oscar lineup, and he scored a nomination himself, original song for “Everybody Needs a Best Friend,” the tune he co-wrote for his big-screen directing debut “Ted.”

“That’s kind of cool I got nominated,” MacFarlane deadpanned at the announcement. “I get to go to the Oscars.”

Walt Disney predictably dominated the animated-feature category with three of the five nominees: “Brave,” ”Frankenweenie” and “Wreck-It Ralph.” Also nominated were “ParaNorman” and “The Pirates! Band of Misfits.”

“I’m absolutely blown away,” Rich Moore, director of “Wreck-It Ralph” said by phone. “It is weird at 5:30 in the morning to hear Emma Stone say your name. It’s surreal.”

“Lincoln” is Spielberg’s best awards prospect since his critical peak in the 1990s, when he won best-picture and directing Oscars for “Schindler’s List” and a second directing Oscar for “Saving Private Ryan.” The 12 nominations for “Lincoln” matched Spielberg’s personal best on “Schindler’s List,” which won seven Oscars.

Spielberg’s latest film could vault him, Day-Lewis and Field to new heights among Hollywood’s super-elite of multiple Oscar winners.

A best-picture win for “Lincoln” would be Spielberg’s second, while another directing win would be his third, a feat achieved only by Frank Capra and William Wyler, who each earned three directing Oscars, and John Ford, who received four.

“Lincoln” also was the ninth best-picture nominee Spielberg has directed, moving him into a tie for second-place with Ford. Only Wyler directed more best-picture nominees, with 13.

Day-Lewis and Field both have two lead-acting Oscars already, he for “My Left Foot” and “There Will Be Blood” and she for “Norma Rae” and “Places in the Heart.” A third Oscar for either would put them in rare company with previous triple winners Ingrid Bergman, Walter Brennan, Jack Nicholson and Meryl Streep. Katharine Hepburn is the record-holder with four acting Oscars.

An Oscar for Jones would be his second supporting-actor prize; he previously won for “The Fugitive.”

“Lincoln” composer John Williams — whose five Oscars include three for the music of three earlier Spielberg films, “Jaws,” ”E.T. the Extra-terrestrial” and “Schindler’s List” — earned his 43rd nomination for best score, extending his all-time record in the category.

The Oscars feature a best-picture field that ranges from five to 10 films depending on a complex formula of ballots from the 5,856 voting members of the Academy of Motion Picture Arts and Sciences.

Winners for the 85th Oscars will be announced Feb. 24 at a ceremony aired live on ABC from Hollywood’s Dolby Theatre.

___

Online:

http://www.oscars.org

___

AP Movie Critic Christy Lemire contributed to this report.

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Institute of Medicine Studying Concussions in Young Athletes

The Institute of Medicine, a federally financed research group, has started a 15-month investigation into sports-related concussions sustained by young athletes.

An ad hoc committee of scientists, which held its first meeting Monday, “will conduct a study on sports-related concussions in youth, from elementary school through young adulthood, including military personnel and their dependents,” according to the Web site of the institute, part of the National Academies of Science.

The committee will look at the causes of concussions and the “relationships to hits to the head or body during sports, and the effectiveness of protective devices and equipment.”

The committee will also review screening, diagnosis, treatment and long-term consequences of concussions and head hits.  

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Wall Street Flattens Out

Stocks rose ever so slightly on Wall Street on Thursday as stronger-than-expected exports in China, the world’s second-biggest economy, raised hopes for a more robust recovery in the global economy this year.

The Standard & Poor’s 500-stock index added 0.2 percent, the Dow Jones industrial average rose 0.1 percent and the Nasdaq composite index was flat in morning trading.

Data showed China’s export growth rebounded sharply to a seven-month high in December, a strong finish to the year after seven straight quarters of slowdown, even as demand from Europe and the United States remained subdued.

Ford shares gained 3.2 percent after it doubled its first-quarter dividend to 10 cents a share, despite a recent drop in market share.

Adding to the bullish sentiment, Spanish benchmark government bond yields fell below 5 percent to a 10-month low on the back of a strong bond auction that raised more than the targeted amount. European stock markets were mostly higher after the European Central Bank kept benchmark interest rates steady.

“The market’s more positive and it owes a lot of that to the Chinese economic data,” said Art Hogan, managing director of Lazard Capital Markets in New York, adding that the success of the Spanish auction was also of note.

Shares of the upscale jeweler Tiffany dropped 6 percent after it said earnings for the year through Jan. 31 will be at the lower end of its forecast.

Molycorp shares dropped 20 percent after the company said revenue and cash flow would be lower than expected this year due to lower rare-earth prices.

Nokia shares jumped 14 percent on Wall Street after the Finnish handset maker said its fourth-quarter results were better than expected and that the mobile phone business achieved underlying profitability.

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Weight-loss regimen a preferred choice for countering diabetes

After all those well-intentioned New Year's resolutions have yielded to the force of habit, many of the nation's 79 million obese adults will have a day of reckoning with their primary care physicians.

Lose weight and get active, the doctor will order, or risk developing diabetes. Then the MD will scribble a prescription.

For most patients, the prescribed treatment will not be a pill. It will be a 12-week program aimed at preventing Type 2 diabetes by getting obese adults to shed as little as 10 pounds and exercise for a little more than 20 minutes a day.

That regimen — the Diabetes Prevention Program — may soon become the blockbuster prescription medicine you've never heard of. In 2013, it is poised to become the envy of pharmaceutical companies, a new rival to programs such as Weight Watchers, and a target of opportunity for healthcare entrepreneurs.

Led by a trained coach, it is a testament to the power of a mentor and of setting modest goals in spurring healthful behavior. And it may be a crucial first test of the Affordable Care Act's focus on preventive health.

In nearly 30 clinical trials, scientists have established that the program is far more effective at helping people lose weight and prevent or delay the onset of diabetes than "usual care" — essentially, a doctor telling a patient to slim down and get active, and then sending him on his way. But the program hasn't been packaged in a form that healthcare providers can simply and cheaply offer to patients, said Dr. Jun Ma of the Palo Alto Medical Foundation Research Institute, who studies diabetes prevention.

The Diabetes Prevention Program is not rocket science. In 12 weekly sessions, a coach teaches obese subjects at high risk of developing diabetes to set goals for losing 5% to 7% of their body weight, limit the fat and calories they consume, track their food intake, get at least 150 minutes of exercise each week, and devise strategies to avoid gaining back lost pounds.

In trials, subjects who attended the tightly scripted sessions and followed the regimen were far more likely than those who were on their own to reach their weight-loss goals in three months — and to keep that weight off for more than a year. By doing so, they drove down their risk of developing Type 2 diabetes by 58%, according to a landmark report published in the New England Journal of Medicine in 2002.

The program, in short, is powerful medicine.

"If you could take it as a pill, it would definitely be commercialized," said Sean Duffy, a software designer and former Google employee who launched an online version of the program about a month ago.

In June, a panel of physicians and public health experts that advises the Department of Health and Human Services gave the program a mighty push into everyday medical practice. The U.S. Preventive Services Task Force recommended that doctors refer their obese patients to "intensive, multicomponent behavioral interventions" designed to promote weight loss and physical activity. It cited only one that met its strict standards: the Diabetes Prevention Program.

Under the Affordable Care Act, that carries significant weight. Starting in June, most health insurers will be required to make proven weight-loss and behavior-modification programs available without a copayment to obese customers with a doctor's referral.

No one knows whether expanded coverage of such programs can save money and head off a public health disaster. But without it, experts believe a tidal wave of Type 2 diabetes and heart disease — with a 20-year price tag estimated at $550 billion in the U.S. alone — is a virtual certainty.

For all its promise, the program has remained little more than a good idea — and a pretty expensive one at that — for years. The researchers who developed it at the University of Indiana pegged the cost of the trial's intensive 12-week phase and nine months of maintenance at about $1,300 per patient. To make it cheaper and more accessible, they trained a few YMCA chapters to deliver the program.

Today, about 75 chapters in 28 states and the District of Columbia offer it. The Centers for Disease Control and Prevention, which has been charged with broadening access to "lifestyle change" programs, disbursed $6.75 million in 2012 to encourage health insurers, public health advocates and employer groups to offer versions of the program.

But with more than 78 million people potentially in line to get it, demand far outstrips supply.

Researchers like Ma have been working on ways to use technology to make the program more widely available. In a study published last month in the Archives of Internal Medicine, she and her colleagues found that putting the 12-week curriculum on an inexpensive DVD and assigning a coach to answer questions and offer support helped 37% of obese participants lose 7% of their body weight — a rate more than twice as high as for those who got no help at all.

In a related study published in the same journal, researchers gave obese volunteers a personal digital device to monitor their weight, diet and physical activity and had them check in with a coach every other week. The volunteers lost more weight than trial subjects who were on their own.

The UnitedHealth Group's Diabetes Prevention and Control Alliance in Minnetonka, Minn., has worked to make the Diabetes Prevention Program available on demand to Comcast cable subscribers nationwide. UnitedHealth Group physicians and public health specialists worked with a TV production crew to create a reality-show version of the program. After the pilot aired last year in Philadelphia and Knoxville, Tenn., it took just three weeks to get 700 people to volunteer for a clinical trial of the TV-based program. The results of that will be published soon, said Dr. Deneen Vojta, chief clinical officer for the UnitedHealth program.

"These people lost a ton of weight," she said.

The growing scientific consensus around the diabetes program has not been lost on one of the nation's most ubiquitous and respected weight-loss programs, Weight Watchers. With 20,000 meetings a week across the United States, Weight Watchers International has the infrastructure that the Diabetes Prevention Program lacks. Like the diabetes program, its groups are run by coaches who give advice and encouragement and teach members to track their intake. The company has steadily added features — most recently a spate of food-tracking apps — as clinical trials showed their value.

Weight Watchers has been lobbying the government to recognize its programs as an effective tool for diabetes prevention. The stakes are huge: If insurers were required to cover the costs of patients' Weight Watchers memberships, the customer base could expand by leaps and bounds.

In Britain, the National Health Service will pay for the company's initial 12-week course, said David Kirchhoff, chief executive of Weight Watchers International in New York City. Given the program's widespread presence in the U.S. and evidence of its effectiveness in clinical trials, it makes sense for insurers here to pay too, he said.

Entrepreneurs are also getting in on the act. Duffy's San Francisco-based startup, Omada Health, launched an online version of the Diabetes Prevention Program called Prevent that may be the first of many digital spinoffs.

Designed to win the CDC's seal of approval, Prevent resembles a Facebook version of the Diabetes Prevention Program while preserving the privacy of customers who prefer it. Incoming members are matched to a group, and everyone works toward a goal of losing 5% to 7% of their body weight in 12 weeks under the supervision of a coach. Members' weights are transmitted to the coach by a digital scale upon enrollment and weekly thereafter.

Early testing has shown that as groups jell, members learn from — and lean on — one another, Duffy said. He plans to sell the program at about $120 per month for four months, primarily to insurers and companies for use by their customers and employees.

Payment will be due only after users show results, he said.

melissa.healy@latimes.com

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Google Maps of <em>Django Unchained'</em>s Plantation and Other Infamous Tarantino Locations

Naturally, Quentin Tarantino's new saddles-and-spurs flick Django Unchained has probably attracted at least a few fans of Westerns. But fans of one more recent Western may recognize some of its environs a little too well.

It was partially shot on the same set at HBO's series Deadwood. The Melody Ranch in Santa Clarita served as the frontier for Django (Jamie Foxx) and Dr. King Schultz (Christoph Waltz) and as the home of the foul-mouthed denizens of Deadwood, South Dakota.

But that's just a set. Many of the locations used by Tarantino in the past are actual places that you — yes, you! — can visit anytime. (Well, most of them. The infamous diner from Pulp Fiction got torn down some time after the film's release. There's an auto parts store there now.)

Click through the gallery above for names and locations to guide your Tarantino pilgrimage.

(Also, check out Badass Digest's video pilgrimage through Tarantino's LA here.)

Above:

Location: Melody Ranch in Santa Clarita, California

Set the scene: The first half of Django follows the eponymous lead character as he's shown the ropes of bounty hunting by Dr. Schultz in small frontier towns in the American South and West — most of which were filmed at Melody Ranch.

Location fun fact: Singing cowboy Gene Autry once owned the place. Gunsmoke was filmed there.

Map:

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Photo courtesy The Weinstein Company

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